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HomeMy WebLinkAbout0923 SEA VIEW AVENUE - Health 923 SEA VIEW AVE,4. ,S4TERV1--L-xIjL- A=090-005 � I 10 �J a � e a Massachusetts Department of Environmental Protection �w Bureau of Resource Protection E Well Completion Reports t Well Driller Please specify work performed: Address at well location: New Well Street Number: Street Name:- 923 _ SEA VIEW AVE C ✓' Please specify well type: Building Lot#: Assessor's Map#: Irrigation —� 090 Assessor's Lot#: ZIP Code: Number Of Wells: 005 02655 City/Town: Well Location BARNSTABLE In public right-of-way: GPS t" Yes C No North: West: 41.60824 70.39684 Subdivision/Property/Description: Mailing Address: Iry click here if same as well location address Property Owner: Street Number: Street Name: 923 CAPE VIEW LLC 923 SEAVIEWAVE City/Town: State: Engineering Firm: BARNSTABLE MASSACHUSETTS ZIP Code: 02655 Board of health permit obtained: ro.Yes C!Not Required Permit Number: Date Issued: W2021 052 �109/09/2021 Massachusetts Department of Environmental Protection ""ram Bureau of Resource Protection-Well Driller Program 3 l k Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock L Choose Bedrock- WELL LOG OVERBURDEN LITHOLOGY _ From(ft) To(ft) Code Color Comment Drop In drill Extra fast or slow Loss or addition stem drill rate of fluid 0 20 Fine To Coarse S . Brown 1..__.._ _ J YES NO ..,� Loss Addition _ I{{I 20 !30 Fine To Coarse S+ Brown `� Fast Slow 1 YES NO __�___�__ 1( loss Addition WELL LOG BEDROCK LITHOLOGY _ Drop in Extra fast or Loss or Visible Rust Extra LM(ft) To(ft) Code Comment addition of Large drill stem slow drill rate fluid Staining Chips _ � Choose Code h� r':Yes Yesj YES N0� Fast Slow Loss Addition _._ _ ADDITIONAL WELL INFORMATION Developed -Yes No Disinfected Ye C No Total Well Depth 30 Depth to Bedrock Surface Seal Type lNone �racture Enhancement 'Yes C No CASING I�,Is Casing above ground? - —-— -- .... .. ... ............................... .. .... From To Type Thickness -� Diameter Driveshoe __.. yl - - 1 0 !! (26 Polyvinyl Chloride Schedule 40 + 4 Yes! --J i _ -� �� _... a SCREEN JJ No Screen From i To Type Slot Size Diameter 26 30 Stainless Steel W Point�. 0.012 WATER-BEARING ZONES r'DRY WELL, From To Yield(gpm) 15 30 12 ............... ... .._......_... PERMANENT PUMP(IF AVAILABLE) Wire Constant Speed r112] Pump Description Horsepower Pump Intake Depth(ft) Nominal Pump Capacity(gpm) ANNULAR'SEAL I FILTER PACK JWa ter Batches Method Of From To Material Weight Material --[Weight (gal) (count) Placement LtMassachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program - Well Completion Reports(General) 1 - ---------------- .................. Choose Material Choose One-Choose .................................... .................... WELL TEST DATA Date Method Yield(gpm) Time Pumped Pumping Level(ft Time To Recover Recovery(ft (HH:MM) BGS) (HH:MM) BGS) 09/15/2021 Constant Rate Pump 12 1 30 00, 15 WATER LEVEL 7— Date --i :— Measured � . - - Static Depth BGS(ft) Flowing Rate(gpm) ........... ............................................. ji2 .............. COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. WILLIAM Monitoring[M] Supervising Driller DESMOND, DrillerURQUHART Registration# 877 Signature PATRICK, DESMOND,WELL Date Job Complete Firm DRILLING INC. Rig Permit# 024 F NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. ENVIROTECH LABORATORIES,INC. MA CERT. NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 . Sandwich,MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 Client Name: Desmond Well Drilling Location Address: PO Box 2783 923 Seaview Ave Orleans, MA Osterville 02653 Lab Number: DW-214519 Collected By: Client Date Received: 09/15/21 Sample Type: Irrigation Well Specs: 30/15 Wt+fitd- Comm, uR "WF Location Source` "' 'Date Collected, Time Collected 1 Commen01 ts . ry. 09115/21. 11.4 V�1eI,Urm atfon Analysis Requested 3u Units (Recommended Limits Analysis Result Method Dut 'A Analyzed By . PH pH units 6.5-8.5 6.07 SM 4500 H B 09/15/2021 SD . . _ Specific Conductances' umhos/cm 500 323 EPA 120.1 09/15/2021 SD Nitrite-N mg/L 1.00 <0.006 EPA 300 0 69/15/2621 SD _:.:._. _ _ - Nitrate-N mg/L 10.0 1.30 EPA 300.0 09/15/2021 SD Sodium. mg/L 20.0 37 EPA 2001 09/11/2021 KB Total Iron mg/L 0.3 <0 01 EPA 200.7 09/17/2021 KB Manganese mg/L 0.05 0.014 EPA 200.7 09/17/2021 KB Total Coliform(Presence/Absence). Present/Absent Absent A SM9223B 09/15/2021 KB @ 1900 Comments: PH is below recommended limit and may have corrosive characteristics. Sodium level is not a health hazard. All samples were analyzed within the established guidelines of US EPA approved methods with all requirements met, unless otherwise noted at the end of a given sample's analytical results. We certify that the following results are true and accurate to the best of our knowledge. Water meets EPA standards and Is suitable.for drinking for parameters tested. Date �9J18/2021 i ,...._ Ronald J.Saari Laboratory Director BRL=Below Reportable Limits "See Attached Page 1 of 1 OCertifrcation is not available for this analyte for potable water samples.. TOWN OF BARNSTABLE LOCATION SEWAGE# 5—le VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY C>lS Cn LEACHING FACILITY: (type) gS (size) )' ..; NO.OF BEDROOMS $ OWNER C �e QW l.LC, PERMIT DATE: COMPLIANCE DATE: Za Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY LF� No. ao — (/Ja Fee BOARD OF HEALTH t�' TOWN OF BARNSTABLE ZIppYtcattou -for Yell Cori.5tructtou Vermtt i F Application is hereby made for a permit to Construct X, Alter( ), or Repair( an individual well at: Location-Address Assessors Map and Parcel q23 CgQe Vi�.w LL(, S� COLM�)'td41xf K\,Sl #20wp f,�. Owner U 1 Address ,bQsmDnclw"I Dr, IImo(A, IV)C, F0 )BOX 2-793 drw-cans N4A. 02(a53 Installer-Driller Address Type of Building / Dwelling y( Other-Type of Building No. of Persons Type of Well S,C+j + p VC— Capacity Purpose of Well 1 r r)U xti o n Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificatea Compliance has be�* suedde Board of Health. Signed . a- Ate Application Approved By � pZ J Da Application Disapproved for the following reasons: Date Permit No. WC r2, Vo- —' Issued ! z Date BOARD OF HEALTH TOWN OF BARNSTABLE Certtftrate of Comphauce THIS IS TO CERTIFY,that the individual well Constructed(X- Altered( ), or Repaired( ) Installer at q Z,�> 5, V lQ Ave, 0,�-D'Yq-r\/; L iP_ has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. t� Date Inspector n � p ti s No. 1� _ /�s ] ' Fee `f�, y `4 BOARD OF HEALTH 4 TOWN OF BARNS-TABLE Tippricatiou -for Vern Cou6tructiou Permit Application is hereby' made for permit to Construct Alter( Repair(pp p (�;), or Re air an individual well at: w� Location-Address -' Assessors Map and Parcel VheW L LC. _ Owner r Address { �.mor)J UkjI T)riIIIY11j ► I�IC . FQ eay 279:3, Cyr �canS ,MA 02(05,3 Installer-Driller Address Type of Building Dwelling Other-Type of Building µ No.of Persons' A Type of Well C"{l_4-n.. _U p .a�;'_ -Capacity - �� . Purpose of well r 1 G(d 16 Y) v Agreement: z, The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private WellXrotection Regulation-The undersigned further agrees not to place the well in operation until a Certificate o f Complian(e;has.been�issuedby the Board of Health. Signed <uy L�� �� lIY�" 9 } 1 1 Date M ' A lication A roved B 11 - + PP PP Y Date " Application Disapproved for the following reasons: II Date Permit No. lA,/:;�� �_ Issued r Date a---------------------eve-------------------------seam------------ ------------------------------------ BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed( ); Altered( ), or Repaired( ) .byan10 . il) ,� I �►Jl 1 I`I Yi(JI �1f Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date 0(-;l 0 7? 15 a Inspector BOARD OF HEALTH TOWN OF BARNSTABLE lVell-Cou,5truction Permit ` No. LL/D . Fee `7 Permission is hereby granted to .�-a n'1Y1 ' -"' -C)y t� 1 1 Inc—, ` Installer to Construct. ), Alter( ), or Repair( an individual well at: Street �-y as shown on the application for a Well Construction Permit NoIt O,�I - � ( Dated Date 14/�rA Approved By. ! "r ASSESSORS REF.: 44'.' OVERLAYDISTAICT: FLOOD ZONE: F -' ` Sea View.'Avenue t !',�I 4 .. �.I C' � r _l•'�'-l/ DIRECTIONS:. ._. REFERENCES'L_.O_..C.Z ArOT!NnIO Et OTCALCULATIONS - —-� �L!� 'r:, �' :,.y 's,,.c•.t:.. a cs;r la.r) ' ; -1 �'K't"14r rN"�,' / � •,� _ •-\ .\ • ~� ia._ rib s[T..:.y l 1. ( ( Nantucket Sound i•3y Site Plan Proposed Improvements 1l1' E oneeafDg$ at SulllYUll ConaWdog.fnc =i- c`:->•'u� _ u ";:,: 923 Sea View Avenue aur- ..awm.moaw.wo.na,wwrn 'GC--:V'F;a.V Barnstable Im ��Mass. •.... .,��. c. ._ .• 12 YI D h i l 1. 325 O = t l.L S fb-m- in 1 Acres; t 1 tFA --� t 1 EL. r ��, l t _i �• t E 77NGs"tMT7CS' ` T BE�?EMOI�EDI� - � — €o �= ! ) a,4klK �. ram: i I GC1rdzli HJU5 P �J vent N55. 4' I WH r i DD% f Wt m ESER:VE ROP 5ED S.A.-,,! s 47 Ira ;RoPP$ED , w s D 1 171 a Wn 10' j__ i 4 MIN C( ANOUTS pProx 23 \ J PROP05ED ,ctia T i i, 6 - Town of Barnstable Inspectional Services : Public Health Division • eAarrsraei.s, • i6� Thomas McKean,Director °i 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 f Fax: 508-790-6304 Ca Crr Installer & Designer Certification Form Date: Zo 2°Z� Sewage Permit# 2017 --19Z Assessor's Map\Parcel Q qo 0* Designer: ft,cl 1,?� �E-Ar,'Ae Pr•h� Installer: lo(\ CAL Address: -7 l _/"74 1 4 . Address: On TX h 1Cp� -Voy�e was issued a permit to install a (date) I (installer) S ��. septic system at 923 pa � �Q%°� l{JF cv,1,/ based on a design drawn by 4-a (address) dated fz Ir Zo/j (designer) certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. oIce rti at the system referenced above was cons c \ Ail' ce with the terms of approval letters (if applicable) Sqe H .FLES T• W I" 5L Installers Signature) �pFFSSft)H (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. WoAdeptAHEALTHISEWER connecASEPTICOesigner Certification Form Rev 8.14-13.DOC No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes-; PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Y� 1. 2ppliCation for MispoBal *pstem Construction Permit lip Application for a Permit to Construct(Vl� Repair( ) Upgrade( ) Abandon( ) Jg Complete System ❑Individual Component`�s A In Location Address or Lot No.y23 .ram VvA, ALI Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 0Q0 Q0 Installer's ame,Address,and Tel.No. Desi ner' Name,AIOA d ress and Tel No S.Type of uilding: y Dwelling No.of Bedrooms 9 Lot Size 4/7?8 j3 sq.ft. Garbage Grinder( ) Other Type of Building Re 5- 4`i4i'4 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 860 gpd Design flow provided 933 gpd Plan Date S A C,/9 Number of sheets Revision Date Title S,C_ PlQm Size of Septic Tank 2 000 &1?C46., Type of S.A.S. $"SVO 6ql JAI e Description of Soil `�'H_ <� o-2 O "' 1Fi'fl 2® A 4,q e f- Sq td 2 c>— `rG O _ ✓�/- L ct,-, Ya-<YY C f g t/-e_e- /t'l e�;yss� Sr N , Nature of Repairs or Alterations(Answer when applicable) Date last inspected: q Agreement: �o CGA k-1-j The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmenta �r►d-rrIItt�pla a the system in operation until a Certificate of tJ�/ Compliance has been issued by this Bo /T. � s ed Date rb. Application Approved by ate Application Disapproved by Dat _sy for the following reasons Permit No. Dat sued IVo Fee THE COMMONWEALTKOF MA Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes- . Y 2ppIication for Misposal *pstem Construction permit Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual ComponerjR Location Address or Lot No. Y23 .`ew V `'a Owner's Name,Address,and Tel.No. ch Z S 6 Assessor's Map/Parcel C ✓ O� ��1, �. ��- �"� ��J L Installer's Name,Address,and Tel.No. Designer, Address,and Tel.No. Sir •Vow IrlI is,Por.nS rCohSvhY�tS ��n Ca' `. ;o8-YZE-3 yy Type of Building: Dwelling No.of Bedrooms B Lot Size 11 9815 sq.ft. Garbage Grinder( ) Other Type of Building P<S. rh 4; 9 No.of Persons Showers ) Cafeteria( ) Other Fixtures Design Flow(min.required) �'0 gpd Design flow provided '�33 gpd Plan Date IS / ? Number of sheets Revision Date Title J"_t� Q�4N Size of Septic Tank L 000 C 4//pr+ Type of S.A.S. Description of Soil -r H- 0-2 O " lam, f'l c G G Q, >f!q P r S,;7 �� i{f Q ( n+,i� 3•n o� C:(YY /A,�<< /�Ad,l/M s4 r, f Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: d W I T--41- .?f 1 5 �v , The undersigned agrees to ensure the construction and maintenance of the ore described on-site sewage disposal system in ' accordance with the provisions of Title 5 of the Environmenta and not to pla a the system in operation until a Certificate of Compliance has been issued by this Bo ed Date Application Approved by ? 1L• Date Application Disapproved by Date for the following reasons i f ' Dat ssued 'Permit No. I , • ---------------- --------- '---------------------—--------------------—------------ -- -------- --- - ---- - ------ - , -- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed Repaired( ) Upgraded( ) Abandoned( )by 4•�',,,� r Ir ! o at �'3 S' U'r'�. t G c 4 2 5 C has been cons c 4 ac ce with the provisions of Title 5 and the for Disposal System Construction Permit No. ted Installer Designer S j/1 P'7/w S ih ee f"h S #bedrooms r Approved desigRw 8G gpd The issuance of thil pe t shall not be c�nstrued as a guarantee that the system will(fimcjl n designed. Date V a , Inspector ! J No. - - -- - G- -- -- - - -------------------------Fee--- n � qm - '-THE COMMONWEALTH OF MA SSA H USETTS �Q PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bis osal 6pstent Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at ��<=- ,i Loot N Lc/ ,fF w e (G.o-- 21;0 ,and,as described irrthe above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction;n t p to ithin three years of the date of this permit. Date Approved by_ k " I I 7 Legend 1.0�'WO. 50 Parcels el a �.� a Town Boundary � = w f t Railroad Tracks .. . . .....y..,.. °�. . ..... ..... #936 BUIIdIr1g5 y'S s #96 5� fi /~ !' /� #�'j �t — _ _ r r)Approx.Building y - rj' Buildings — - - _ _ Painted Lines Parking Lots Qj Paved Unpaved tid .• :€ Driveways Xr\` � Paved a E!Unpaved #€95., Y . Roads a '"i:' [ w7 - E �: _ *,. 'i;"�l .,.. - Paved Road i t I ` .l �� I i `_'Unpaved Road ..+;,..�,. Es � PavedMedian Brige I I — Streams a 1 1 # 1 S , #1 L� � � � � _ �� � = � Marsh .,� ��� 13 Water Bodies 905 #Q7 I = 0, �wr IV a� CIN a Map printed on: 5/20/2019 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Bar"nstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are 'wl.. Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,-Hyannis,MA 026ot 0 167 333 0 an on-the-ground survey.it may be generalized,may not accurate relationships to physical objects on the map 5o8-862-4624 reflect current conditions,and may contain such as building locations. Approx.Scale: i inch= 167 feet cartographic errors or omissions. gis@town.barnstable.ma.us SUBDIVISION PLAN OF LAND IN BARNSTABLE 2664--.124 Baxter & Nye Inc., Surveyors February 14, 1989 36 bA 6° Ap " RD. Pl-t1o25 O N5 _ (86 a 98 N� N P'n No 2g6 ��P 249 Pfon No.2664-122 SEA VIEW C$ AVENUE Sa 20.00 N 66'f0'00 E a YS/,.46 i 1 -120.00 L C 449.92 -�k . . N 'f ' �I Q 1 1 � . N O i4, ;;�.��_" i tin a n���}}-n yy v`s: is°r -a n� � ,eA. 6.9 1 i B-20 h Plon No.2664 U Cod, No,205 n iQj . 1�'5.00 K B-13 N' s 66'f0'00'h' h� L o Plan No.2664 Cart. No.120 � •1. I o r` h IB.a6 i .D. m _ 256 . olr � fl3 °j • �h NANTUCKET SOUND SubdiviAon of Lot 82 ,a,,a Shown on-Plan 2664-77 Filed wT h Cert. of Title No. 5263 Registry,.TOistrict'of Barnstable County Separate certificates of title may be issued for land shown Aeregn'as L ohs 255_pnd 256__ ______ Copy of pert of plan By the 0011`: 1Jled in LAND RE6I57AATION OFFICE J / JUNE 14. 1989 DUNE 14. 1989 —— ——V—_`—'——— d' Scale of tnls plan 100 feet to an Jncn — �! Louts A. Moore. Englneelr for Court KM-f09 �,LO. v AA -3 s (� -40 AaM Sqs4el go �n - � v%4 4, a N /lam., fG / IC3 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH-DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYiration for Disposal *pstrm Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �3 Y %C �— Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 640 5 G Installer's Name,Address,and Tel.No� �J ' Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) /4-e— �5 Tom_ 62 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Envir ental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of It Signed Date Application Approved by Date Application Disapproved by Date for the following reasons r Permit No. ` lyj Date Issued Fee 15 r • THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpplication for Mispo8al *pstem Construction Permit - Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.9-t 5 �j Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 005 Installer's Name,Address,and Tel.Nod:U ��. y%/t� Designer's Name,Address,and Tel.No. Type of Building: ` Dwelling No.of Bedrooms / Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title s Size of Septic Tank Type of S.A.S. Description of Soil -"e f� Nature of Repairs or Alterations(Answer when applicable) ie�.0 Date last inspected: y Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Envirr ental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of alt Signed Date r Application Approved by Date Application Disapproved by _ Date for the following reasons l' Permit No., �(9 y� Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS L Q Certificate of Compliance THIS IS TO CERTIFY,that the On-site S yyage Disposal system Constructed( ) Repaired(V) Upgraded( ) Abandoned( )by �_ .�,Q/7/ ( '/�( !/217C7iL 6 C. 6&,' U at- Yf� \//ill> ✓�)/f� has been constructed in accordance with the provi 'ons of Title 5 and the for Disposal System Construction Permit No-)06 `_'-/3 dated h41 Installer y /1-60DI,o a�/STZ(1 �/GAL Designer #bedrooms / Approved design flow gpd The issuance of this permit sh 11 not be//construed as a guarantee that the system i ctio ed. Date 1pZ X % (O Inspector \J% -----------------//--------------,--------------------------------------------------------------------------------------------------------- No. �t9 —! Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS NspoBal 6pBtrm Construction Permit L� Permission is hereby granted to Construct-( ) Repair(/i') Upgrade( ) Abandon( ) C U System located at 1/f r'(,� - ✓C' and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following,local provisions or special conditions. Provided:Construction must be com•leted within three years of the date of this ermit. Date �o`/ ( Approved b t , 1 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the main house) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 Telephone Number- B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes- ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4/27/16 qb:j' Wd9f�5 inr . Inspecto s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection^does not address how the system will perform in the future under the same or different conditions of use. 923 Sea View(main house)-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the main house) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E I always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Pumping suggested every 3 yrs to prolong the life of the system B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain.` ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: n/a ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed • A 923 Sea View(main house)•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave.. (There are 3 systems at this property this one serves the main house) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: n/a ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The i system will pass inspection if(with approval of the Board of Health): . ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: n/a r C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is-within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 923 Sea View(main house)-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the main house) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. Q ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 923 Sea View(main house)•03108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ( 923 Sea View Ave. (There are 3 systems at this property this one serves the main house) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 Cityfrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes ' No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. ` Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 923 Sea View(main house)-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the main house) Property Address Foy Owner's Name Osterville MA 02665 4/27/16 Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes".or"no" as to each of the following: Yes No k , ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] 923 Sea View(main house)-03108 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the main house) Property Address Foy Owner's Name Osterville MA 02655 '4/27/16 Citylrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 11 Number of bedrooms (actual): 11 DESIGN flow based.on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): per plan Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: seasonal Date Commercial/Industrial Flow Conditions: Type of Establishment: + n/a Design flow(based on 310 CMR 15.203)- Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): n/a 923 Sea View(main house)-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the main house) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: No recent pumping per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons , How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1998 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No 923 Sea View(main house)-03/08 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments < 923 Sea View Ave. (There are 3 systems at this property this one serves the main house) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 City/Town State Zip Code . Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 18' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: >10 feet Comments(on condition of joints, venting, evidence of leakage, etc.): , Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: > 2500g Sludge depth: 'trace-1" Distance from top of sludge to bottom of outlet tee or baffle >12' Scum thickness trace >211 Distance from top of scum to top of outlet tee or baffle >2,r Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Measured 923 Sea View(main house)•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts u Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 923 Sea View Ave. (There are 3 systems at this property this one serves the main house) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3 yrs to prolong the life of the system Grease Trap(locate on site plan): " Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): n/a Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): n/a Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): n/a 923 Sea View(main house)•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the main house) Property Address Foy Owners Name Osterville MA 02655 4/27/16 City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: + Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level_' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): n/a "Attach copy of current pumping contract(required).Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box is 2' below grade and in very good condition, H-20 box Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ ,,No Alarms in working order: ❑"Yes . ❑ No 923 Sea View(main house)•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the main house) Property Address Foy _ Owner's Name Osterville MA 02655 4/27/16 CityfTown State- Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 10 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure,.level of ponding, damp soil, condition of vegetation, etc.): Chambers were dry at the time of inspection, H-20 chambers in the driveway per plan on file, no adverse conditions 923 Sea View(main house)+03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,� ' 923 Sea View Ave. (There are 3 systems at this property this one serves the main house) Property Address Foy Owner's Name Osterville MA 02655 : 4/27/16 City Fown State Zip Code Date of Inspection D. System Information (cont.) Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction:, Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): n/a 923 Sea View (main house)•03/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 15 r - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .' 923 Sea View Ave. (There are 3 systems at this property this one serves the main house) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. cjC, `« 161(0 {� 3,4 /1 1r 6 v Li 923 Sea View(main house) 03/08 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 14 of 15 • Commonwealth of Massachusetts Title 5 Official Inspection Form ; Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the main house) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 CityTrown State Zip Code Date of Inspection D. System Information (cont.) . Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >12' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record ' If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation). ® Accessed USGS database-explain: Property is 14'above sea level You must describe how you established the high ground water elevation: see above 923 Sea View (main house)-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this is the cottage) ' Property Address Foy Owner's Name Osterville MA'' 02655 4/27/16 Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information �1�0 / 1. Inspector: / Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code- 508.272.6433 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority qv it od gis mr._ 4/27/16 Inspecto ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10;000 gpd or greater, the inspector and the system,owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner. and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection..does not address how the system will perform in the future under the same or different conditions of use. 923 Sea View Ave (Cottage)•03108 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 923 Sea View Ave. (There are 3 systems at this property this is the cottage) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Pumping suggested every 3 yrs to prolong the'life of the system B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: n/a ❑ Observation of sewage backup or breakout or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 923 Sea View Ave (Cottage)•03/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments � 923 Sea View Ave. (There are 3 systems at this property this is the cottage) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: n/a ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: n/a C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 923 Sea View Ave (Cottage)•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s 923 Sea View Ave. (There are 3 systems at this property this is the cottage) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): The stem has a septic tank and SAS and the SA i I than 1 f❑ system p S s less a 00 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool . ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool 0 ® Liquid depth in cesspool is less than 6" below invert or available volume_ is less than %day flow Required pumping more than 4 times in the last year NOT due to clogged or Ell Z. obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. 0 ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 923 Sea View Ave (Cottage)•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this is the cottage) Property Address Foy Owners Name Osterville MA 02655 4/27/16 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 923 Sea View Ave (Cottage)-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this is the cottage) Property Address Foy Owner's Name Osterville MA 02655 4/27/16' City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank'manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with. information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 923 Sea View Ave (Cottage)•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 r- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this is the cottage) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 Citylrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): n/a Number of bedrooms(actual): 1 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: seasonal Date Commercial/Industrial Flow Conditions: Type of Establishment: n/a Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): - Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): n/a 923 Sea View Ave (Cottage)•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this is the cottage) Property Address Foy Owner's Name Osterville MA 02655 . 4/27/16 Citylrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: No recent pumping per owner Was system pumped as part of the inspection? ❑ Yes 0 No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of-the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: > 1970 per materials used Were sewage odors detected when arriving at the site? ❑ Yes ® No 923 Sea View Ave (Cottage)•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 923 Sea View Ave. (There are 3 systems at this property this is the cottage) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 12" Depth below grade: feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 6" Depth below grade: feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000g 3„ Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle '12 Scum thickness trace Distance from top of scum to top of outlet tee or baffle >211 >2„ Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Measured 923 Sea View Ave (cottage)-03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this is the cottage) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 Cityrrown State Zip Code Date of Inspection D. System Information .(cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3 yrs to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): n/a Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: ' Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): n/a Tight or Holding Tank(tank must be pumped at time of inspection)'(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): n/a 923 Sea View Ave (Cottage)•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this is the cottage) Property Address Foy Owners Name • . 9 Osterville MA 02655 4/27/16 CityrFown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): n/a "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution•to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box in average condition for its age Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 923 Sea View Ave (Cottage)•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this is the cottage) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a w Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type. ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number:_ ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit is dry at this time, top of pit is 18"below grade, no indication of past backup 923 Sea View Ave (Cottage)•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M yt 923 Sea View Ave. (There are 3 systems at this property this is the cottage) Property Address Foy Owner's Name Osterville MA 02655 4127/16 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑' No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): n/a 923 Sea View Ave(Cottage)•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this is the cottage) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. alo a � t14 923 Sea Yew Ave (Cottage)•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this is the cottage) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 City(rown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: pate ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: Property is approximately 14'above sea level You must describe how you established the high ground water elevation: see above 923 Sea View Ave (Cottage)-03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 �'_� Commonwealth of Massachusetts ,F . � W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the garage apartment) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ® -Conditionally Passes ❑ Needs Further Evaluation by the Local Approving Authority all 4/27/16' Inspe I a Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. "*"This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 923 Sea View(Garage)•03108 " Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the garage apartment) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: This system is a cesspool to an overflow cesspool. The piping from the apartment that goes directly to the overflow is in violation. It is reccomended that this piping be rerouted to the cesspool ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 923 Sea View(Garage)-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the garage apartment) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 CitylTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: n/a ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: n/a C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 923 Sea View(Garage)•03108 Title 5 Official Inspection Foam:Subsurface Sewage Disposal System•Page 3 of 15 } Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M y 923 Sea View Ave. (There are 3 systems at this property this one serves the garage apartment) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 Cityrrown State Zip Code Date of Inspection B. Certification (cont:) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other. n/a D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6 below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped:, ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 923 Sea View(Garage)•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the garage apartment) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. , For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 923 Sea View(Garage)•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s M 923 Sea View Ave. (There are 3 systems at this property this one serves the garage apartment) Property Address Foy r Owner's Name Osterville MA 02655 4/27/16 Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined?(if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 923 Sea View(Garage)•03r08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 923 Sea View Ave. (There are 3 systems at this property this one serves the garage apartment) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): Na Number of bedrooms(actual): 1 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): n/a Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes 0 No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: seasonal Date Commercial/Industrial Flow Conditions: Type of Establishment: n/a Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if,available: Last date of occupancy/user Date Other(describe): n/a 923 Sea View(Garage)•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There'are 3 systems at this property this one serves the garage apartment) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: No recent pumping per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Cesspool to overflow cesspool Approximate age of all components, date installed (if known)and source of information » < 1970 per materials used Were sewage odors detected when arriving at the site? ❑ Yes ® No 923 Sea View(Garage)•03/08 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the garage apartment) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 12"feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: n/a feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No -----------------------------------------------------------------------------------------------=-------------------------- Dimensions: ` Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee"or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? 923 Sea View(Garage)-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 l , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the garage apartment) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete . ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): n/a Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): f n/a Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): n/a 923 Sea View(Garage)-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the garage apartment) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cunt.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Mann in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): n/a Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert n/a Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: El Yes ❑ No Alarms in working order: ❑ Yes ❑ No 923 Sea View(Garage)•03108 TRIe 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the garage apartment) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 City/Town State Zip Code' Date of Inspection D. System Information (cont.), ' Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Overflow is of block construction, dry at this time, steel cover to grade, no indication of past backup 923 Sea View(Garage)•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this ore serves the garage apartment) u,p - Property Address Foy Owner's Name Osterville MA 02655 4/27/16 City,rrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration cesspool to overflow Depth—top of liquid to inlet invert >4, 12 Depth of solids layer Depth of scum layer trace-1/2" Dimensions of cesspool 6x16 Materials of construction Block Indication of groundwater inflow ❑ Yes ® No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Cesspool has 1' of effluent in it at this time, steel cover to grade, no indication of,past backup, outlet T in place Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): n/a 923 Sea View(Garage)•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the garage apartment) Property Address . Foy Owners Name Osterville MA 02655 4/27/16 Cityfrown State Zip Code Date of Inspection D. System Information (cost.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. f C - 923 Sea View(Garage)-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 923 Sea View Ave. (There are 3 systems at this property this one serves the garage apartment) Property Address Foy Owner's Name Osterville MA 02655 4/27/16 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >12' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS)• ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: Property is approximately 14'above sea level You must describe how you established the high ground water elevation: see above 923 Sea View(Garage)•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 R TOWN OF BARNSTABLE LOCATION ?ziy vee?`� SEWAGE # � T � VILLkkjE ®S �l/l�`!('� ASSESSOR'S MAP & LOT d9® O S INSTALLER'S NAME&PHONE NO. / GO � SEPTIC TANK CAPACITY 4Q�J 4 A-L— � � o LEACHING FACILITY: (type) "1� s NO.OF BEDROOMS BUILDER OR OWNER�y PERMTTDATE: N `" COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If.any wetlands exist within 300 feet of leaching facility) Feet Furnished by Fee THE COMMONWEALTH OF M S ACHUSETTS Entered in computer: Y�. PUBLIC HEALTH DIVISION -TOWN OF BA STABLE., MASSACHUSETTS 2ppri.cation for Mioozaf *proem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) /complete System ❑Individual Components Location Address or Lot No. f 23 Sa L!�rev,J X#-;- Owner's Name,Address ano jel.No. p �- �w A✓� a4�9i, OY Assessor's Ma /Parcel qOZ� / e44o- Installer' Name,Address,and Tel.No. Designer's Name,Address and Tel.No. >�jA/MN�1�J Esc ai�q�99 �c _:Zo � Type of Building: nq 5��/ Dwelling No.of Bedrooms _ Lot Size qsq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures ` Design Flow gallons per day. Calculated daily flow gallons. Plan Date A Number of sheets 2 Revision Date Title + G AA) or &AAA Size of Septic Tank 2S GA 1, Type of S.A.S. 44 L. s Description of Soil Ar c j� /. ¢ �G���,y� �] AAj ,ka)o ay 7 �> �� 11 k ,`i A // T y �ieM I1 ` t� Nature of Repairs or Alterations(Answer when applicable) A>J OLL L.�y S , T !.�- 1Z�s Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by this B and of Health. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued .� `J'.` � .•,. ,�..,+. .. ,EI..,ter...,.-r.,.•.-....n.+„+wr.' pq .. :. ''1 �c ©7,© 1 i No. N r L3►� s Fee�41� THE COMMONWEALTH OF MIS ACHUSETTS Entered incomputer: y` Yes PUBLIC HEALTH DIVISION -TOWN OF BA"STABLE., MASSACHUSETTS 2pp[ication for M!6paal *pztem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade(_ )Abandon( ) IJ Complete System ❑Individual Components , Location Address or Lot-No. I Z?, S � V� �,J a/� Ow is Name,Address an el.No. A�sessor's Map/Parcel o , Q vzu� 42,3 s4a W,6AI ✓�� 0�rn512 el,4 s Installer' Name,Address,and Tel.No. Designer's Name,Address and Tel.No. n �� Type of Building: l ) R 9 5 7� Dwelling No.of Bedrooms / ( Lot Size 4 sq. ft. Garbage Grinder( ) Other• Type of Building No. of Persons Showers( ) Cafeteria( ) - Other Fixtures s Design Flow gallons per day. Calculated daily flow V gallons. Plan Date G� g Number of sheets Revision Date Title Sr GPI-AA) O G' 6 Size of Septic Tank Z500 GA(. Type of S.A.S. ' sD L YLV�L�s , Description of Soil. bli/0 Akv AAPIoo 9 Naturg of Repairs or Alterations(Answer when applicable) tJ 04L 4, ass` -1 yi 05 Date last inspected: Agreement: t , The undersigned agrees to ensu e,the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by tha B d of Health. / Signed Date P Application Approved by Date '" Application Disapproved for the following reasons Permit No. '" Date Issued -- _________________ 9C_ 4-.___ __ THE COMMONWEALTH OF MASSACHUSETTS � BARNSTABLE, MASSACHUSETTS s Certificate of Compliance THIS IS TO CERTIFY -that theOrn-site Sewage Disposal System Constructed( )Repaired ( V)Upgraded( ) Abando ed by ��'���'� ��/ C^ `�`'✓`.� ` at Z �/�eGr/t�'t2 S �I°4,9 has been constructed in accordan e with the provisions of Title 5 and the for Disposal System Construction Permit No -16�'/ dated ' Installer Designer The issuance of this permit shall of be construed as a guarantee that the syste will function as designed. Date ^" 13 Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mizpozaf *pate m(�ongtruction Permit Permission is hereby granted to C nstruct )Repair( )Upgrade( )Abandon( ) System located at 7,Y ��2GC�Q� and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must becompleted within three years of the date of this p rmit. Date: "-�' `" % Approved}��a''yX � a q 2 TOWN OF BARNSTABLE LOCATION:, al4f-f SEWAGE # Y�� ( VILLAGE e5 /1//'/�� ASSESSOR'S MAP & LOT OQO INSTALLER'S NAME&PHONE NO._ / L®rf 1 � sf 7 7/-939op SEPTIC.TANK.CAPACITY 4_SBtS ,1 (_ LEACHING 1~ACILTTY: (type)er4iCU G (size) ..i cJ,e—L NO.OF BEDROOMS BUILDER..OR OWNER AD,y PERMITpATE: �?�'"�� COMPLIANCE DATE: Separation.Dstance Between the: Maxim ffi Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site.:owithin 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300.•feet of leaching facility) Feet Furnished1l3y i I �;►Z . TOWN OF BARNSTABLE p LOCATION 92.3 56y4V�E-w 1,4-vE SEWAGE # 0 7-,5-(2- VILLiGE O ASSESSOR'S MAP & LOT-2Q S INSTALLER'S NAME & PHONE NO. MG Mr-N aAcK`"46 q kS7j SEPTIC TANK CAPACITY IC61) 6!7,�f LEACHING FACILITY:(type) i r/ (size) NO. OF BEDROOMS__/ _PRIVATE WELL OR PUBLIC WATER Rb C., BUILDER OR OWNER DATE PERMIT ISSUED: DATE .COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �,/r rw,Jl• � -����__ 1 {. 1 I {� J 6 O --�.. No.... Fmc 76........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH A -OF........./1��. . ... ...... ... ........................... Appliration for Disposal Workii Tonotrurtion Verutit Application is hereby made for a Permit to Construct or Repair (V) an Individual Sewage Disposal System at: 131-3 ye-COW,......................................................1.4A._._1.........Ave. ai- ................... .................................................................................................. Location-Address or Lot No- ........... C1 3 Sc,-" # .............................. .......................................?.Rr�v...........4ke...........!;a t---- C .............A a ........... .........ktr..... -----A................ Installer Address Type of Building Size Lot. feet U Dwelling—No. of Bedrooms___.._.�5- ...............................Expansion Attic Garbage Grinder a Other—Type of Building ............................. No. of persons_._.__.__.__.______.___._.__ Showers Cafeteria Otherfixtures ..................................................................................................... Design Flow........1&?.............................gallons per person 3­3 day. Total daily flow.........13 6) .................................gallons., y 1:4 Septic Tank—Liquid capacityh=�allons Length....7 - W ......... Width....�!-------- Diameter________________ Depth_i� Disposal Trench---No_ .................... Width_____..._.__.______. Total Length_____.______________ Total leaching area....................sq. ft. Seepage Pit No.........I.......... Diameter.......k2--------- Depth below inlet_.___?._._._...__ Total leaching area_s:51�g sq. ft. Z Other Distribution box ( I ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I________________minutes per inch Depth of Test Pit_._.______________._ Depth to ground water_______________________. fi, Test Pit No. 2................minutes per inch Depth of Test Pit....____.._.________ Depth to ground water........................ 9 -----------------------------------------------------------*-------------­---------------------*------------------------*------------------*---------­"' 0 Description of Soil........................................................................................................................................................................ --------------*----------------*------------*****-------------------------------*-------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------......................................................... U Nature of Repairs or Alterations—Answer when applicable._M_O-VE....5.C--.9TCC- ��-ITTEryl.PT CC- ....................................................................................................................................................................................................... Agreement: - The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I.TL LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed 4��..... ..... ........... .....-- Date Application Approved By...............0\411t)... ......... Date Application Disapproved for the following reasons:................................................................................................................. ......................................................................................................................................................................................................... Date Permit No..........87.2=....S&)............... IssuedL....................................................... Date F�s..... ��. _........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. .. ...................OF.....------....................._............--• Appliration for 'Uiipusal orkg Tamitrnrfion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........... Z 3 - ��v!.. Ave....ai ... -------------------------------------•_... Location-Ajdress or Lot No. 1 ``.. ^^•f� ... 1..v .'_... ! —^ ._.... ` L✓/3.�c_..........dkc-______.____ - Owner Ad ress .•-•••-..&1.R- GAG la c- �!-`-,............: :- � Installer Address Type of Building Size .40__Sq. feet Dwelling—No. of Bedrooms------- ---------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures --------------------------------------------------------------••--•-------------•-•-•-----------------•-•-•---------------•-----------.._.._....--•--• W Design Flow...................._.......................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width........._...... Diameter---------------- Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by---------------------- Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_.--__.---__________---. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ ----••--•--------------------------•--•-.._._..••••-•-•----........----............_._...................................................................... 0 Description of Soil........................................................................................................................................................................ U ------------------------------------=-"•-•----•-------------------•----------•-•--•---•----------------•-------••--------------------••............................................................. W ------------------------------------------------------------------------------------------•---------------------------------------------------------.-.-------------•-----------------------------•••-- U Nature of Repairs or Alterations-Answer when applicable----------------------------------------------------------------------------_................... -----------------------------------------------------------•----------------------•-•-•--•-•-_-•------•------••---------------•-•-----------•-••----------•-------•-•-------••--•------•-------._...•-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T_111P LE j of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. f" r�'1/-S. ..-•---- ---------------•- `Date Application Approved BY �._:_: : ---•-----••---•---------•------- Date — i• f Application Disapproved for the following reasons__________________________________••__________________________,__________________..________.____________________ ...--•----••-•-•••-•-----••-••---••-----••-----•-----------••-•---------------••••--'----••--••--•----------•---------------------•-•-----•••---..._.---••--------------------•---------•-•------•----•- Date Permit No.......8....7 ---�•6�o�---------------••-- Issued.................. ................................ Date THE COMMONWEALTH OF MASSACHUSETTS _ L BOARD OF HEALTH ...._......y7{ ............OF....... ' .........:.-.. .... ...................................... ('11rdifiratr of otitpr itttcrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by------------------ •-•-- = •- • �. -............----------...-••-----•-._.....----•---- '"� ^� - .se is j c�S-C Install' S t 7':�C' at.................... _ -- has been installed in accordance with the provisions of T I T Imo: j of The State Sanitary Code as described in the application for Disposal Works Construction Permit N o.__.__ _______ dated--------------------------_- .................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.............::... �. Q._.._ No.. .,�._. .tr_ FEE.- ....:...r Dispooal Works Tonitrudion rrmit Permission is hereby granted......... yl) µ �. ..._... , .=e.,1- to Construct ( ) or Repair ( an Individua 7Sewage Disposal System at No ----------------- Street as shown on the application for Disposal Works Construction Permit No._$'2_5. ,,1_� Dated.......................................... ...................... am- --` ------------------------•— Board o Heaf 1th BATE.-•-•---------••-•---------•-----------••••-•------••----------------------•---- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS , I I 1 r i I i I I MECHANICAL ----------------------- -- ----------- I X" 1 I I > , CLOSET I I I I I GAMEFOOM I tI I CLOSET Vo 1 I i a ; I I 1 STORAGE 84T(i _ _______________ ___ CLOSET + a t _________________�_______ b ____-- '}-�� ------ ------------- --------------- ------------------------------- > ! 1 � i UNFlMSHED 1 P,1 MECHANICALi ! I e vc r' I- .....___.!.._.__mum_.._.......__.......—.__..........._.__.._.�.__..__.._._—.........._......._....__.__!_.......MAY ........_..._.__.. ,_ .. _ _._ 1T.:7/.T..._...__..__.._._._...._.. I PIAY100M ; ��' / MECHANICAL 0falel¢noArtllkecb lnc. 1 SIA6 NGMO6 / 1I�J f \" glljl JN ft00x O'Donnell/Buckley Residence 923 Sea View Ave Osterville MA 02655 /` o` !• // /i / //� /� " , Basement Floor Plan SCALE:1/4• = V-0. DATE:3/25/19 I I I I j I 1 Catalano Architects Inc. , I 115 Broad Street /h Bostoo,.a.61husetts 47 telephone 617-338-639 \lam'/ facsimile 617.338-6639 j t i •.I i i I 1 ' - I -!- � _____1_��_-i-'_�_,�v I -•� .......... I ! ! + I I , ! i I I 11 I. Ixtvrtrni I � 1 POWDER ROOM; i. .... ' F In 1 ...._-_ —-..-..-_ A(OG l0'/5 i ....-..c.- ..... ......I i T- - ................... i l A..... :.I ....L.�...I... .. ..I ._..... —:. ...__....._t [I i I f I: ` t !_ - __ __ .............I.... f ' ( _j.11"' ......... ...x.l.... 1 1, ,:i. � l,l ....... .. $ ..............� t I �.r K ni _ I �r ! N. :. L........._....... .yW 'I I c s MASTER _ -- i .__ _ ,_.?I _ _ __ _ .._ _.- -- BACK AIR HALL - e_e+.:.m. I ............ ! CLOSET X FRONT!ENTflY d — ' I n I I I !i a - - - - --- ....... I i I MA BjTHR00M ! - y� ; I 1 I 1 E PANTRY ,; ! ...f.:. ................:.......- !1 STAIR HALL o d L.. ... ...... -.,. ... , 0 ❑ r- W :. ...................._ a:xa COAT I w:a CLOSET t.. • I fi . .. -z ! MASTER EOROOM ! AV CLO ET ({ t� 7. I I IT I _................._._................ -<a. _.._.._...........__..._...... ! s c per L --I - .-_ 1 �. 1._ I 1 i I I I ' ! I KITCHEN _ .... ........._...._....k......._f i ' __ ....__ ....... .. I e. ... _ _ ...._ __ _ ........ _ I E I IT ! I , i ! j:�� iI i 1 I I ! , - _.._._ ._., GflEATRDOM r KITCHENSITTING .....1.--1._.._._............_.......................:........._...._............._.._... .................�. 1 ..................... :......1;... ....i... ,.. _. :I I , i! I I ! OIMNG b - _...... - I ! i _ - :{................i .._....._ ............... .........._ I I .. i.. ow:z - - _ DCatalano Arthlte I- '- .I EOUNGE E j 1' .............__....................._.._.._._ ..........._x..........__.... .. 1. .. .i... ...._.. ..................1...—.—'_....._._._....___.....__..._ ................. _............... _.___...----....:...._....._....... '.__...._....i. _...._ _. ...__..... _ �, - O Donnell/Buckley I _.. fit. ._ Residence DqRACE -, 923 Sea View Ave 0sterville MA 02655 so11f 1 - -- — 1 L I r 1.. - _._ _ IL . L , r I f _ - T, -- / t t ;1. _el..y.._.. a - _....... __._. First Floor Plan g _ ._.__. - - SCALE:1/4' 1'-0' .........-..—_:_._._.-_.......:................._.L_..__..-_...z._..._....._._..1.... - f I ! ? I T7-, ! .I_;.,,, __ .............. - _._.._....._ _.__..._.___.._......_ _._..._.... DATE:3/25/19 E. II n ; I , Catalano Architects Inc. II I I I - I , 115 Broad Street j Boston•Massachusetts 02110 i telephone 617-338-7447 faaimile 617-33&6639 I I I 1 i I i � I I I i _ - ems`^ 1 1 I ; I I I I I � I i I ! . b ______ —I_______________ _! 1 I I I I I 1 I 1 i I 1 I i I I I f I I I q I I I I I , --+---- — --------------- --------- ------*— i I r I i j I i 1 i i 1 I 1 i i I t ' 1 I I - I STORAGE STORAGE k.a, — ' — -- _.. 61 ' �t. awel--- CL0.5ET — —-. SrAI HALL -— ——— �K. ......._. ............. ._...-' BUNKHBOM _— A,-_ ....µ� c' i n n • u 1 , ........... ............. .......... ' ......_ `w•a•._nenam_-net-.kv, I i I: 1 I — _ _ _ . � I i RAiWY9 /!....III _ _ GUEST ROO BEOM — / l GUEST . .,.,,_ .. ......... I .I..__...._..j__. I ._.. _..l— -- MOWS -'—.r_..." -'I ------—-—-��------ --—''r— —---------———-- ! �' "' -------- --I I ............!.-._, _ ' .....t. - - "—..—I ®falelmro ANllaxbla. `. O'Donnell/Buckley Residence ' I i 923 Sea View Ave Osterville MA 02655 I i I i I I j L_. .........._....... .........._.-_...............,I Attic Floor Plan 1 I 1 1 1 SCALE:1/9' I i DATE:3/25/19 Catalano Architects Inc. I1 111 115 Broad Street I /.\ BoLZ Massachusetts 47 1--jay-r'► i telephone 617uselts 21 lo facsimile 617.338.6639 4 !i I , 1 I I I I _ I I -40�o I ._._... _.....BF HOOM f3 I a I I � ag I j a � I £ I , , — �._. ...... I I ! I LUS � �M1i57ETR F :...s'ii,.! ..... ! ga I I + I I ..... . _ s £ a I I T .............i'_i..._ t i I.,._M!?s�OATH....... a Jam'- ; LAUND ; ! fl00MNNEN ; .................{.. .. ........... CLOSET Ll/fl FSTAII ' ... .._. AflA .... _.. ' t m . ! r �w K STAIR HALL ..'..L..� ....._._.. i I 1 : , -- - - ! i I i = _................ I 1 MASLEfl.SURE:` ».:. S ._...I i III CLD FTT Il .. ! I I ;• +.t!L. ' ! GUEST § — eE0fl00M7t GUEST....... .._. tom/' 1 �,1xT. OM i2- , nal _ I .....:_.. �___:::a�.._...._..........--._.. En . '•' I CLOSETII - ......£`..-_-- , ...!.....__._... .... cvww'rvy. isa,rz i I , O'Donn ell/Buckle ResidenceY I _ u I i III!! J 1 it I .! 3 f I I !I I I'I! I !I I' !i! I!, I 923!I Se!la aV 1 li BVJ Ave£ 'I Os tervi i !! ! Ile MA 02655 , it i�i I! I i I I! 1 I! li I I ! 1 ii' i li II I• l !: I ! I I. i� II I l I a I I .._J I I! I li I I: I it `li i it II 1 r I !li is 1 li I ! .I tl !! — — Iili ii 116 Se cond Floor Pl an . is II li i II !I �1 i I I_ i i� it I t II !. I t II II i^ i' — i n1 i I n I` V I hli i DA TE I TE 3 9 v 7i I 1 I f i I Catalano Architects Inc. FTi 11S Broad Street Boslan,Massachusetts 021 tO telepher!e 617-336-7441 facsimile 617.33M.6 ASSESSORS REF.: Map 090, Parcel 005 & 004 4 � r OVERLAY DISTRICT. AP — Aquifer Protection District FLOOD ZONE: Zones VE Elev. 15, - X (0.2% Chance), X ` � ; (Min Flood Hazard) Community Panel No. #250001 0757 J �r Apron _..._. July 16, 2014 . _. . . Edge PaveAvenue _.. ,. t _ View,- , V Sea ` k / , 'Edge-Pace. LOCATION MAP. _ A o - ._ r - "f• S85' 26' 4 "W Scale: N85 26 44 E as _ j` Intercom 20:0b �' Qf Wall ,m DIRECTIONS: From Hyannis — Take Route 28 into Ostervilie; At Garage the lights by White Hen Pantry take a left onto \ \R x, A rox./ \\ v, / pp Osterville West Barnstable Road and follow to the Location end' Take a left onto Main Street• Turn ri ht onto 1 f g k West Bay Road and left onto Wianno Avenue. Continue right onto Sea View Avenue. 1 r r \ �¢ R P _ #905 & 923 is on the left. RIVE Std15 8 M. SPK I 11 I j • r v r r � ;:r o9hte. Gravel .EL I w_ l *r - � �.. - r?3`� -_✓...;.. .�.� �,,.aa".' .� {3St Drive r i ;t \ cOPOSED } I` t. Woo / i c• pDSr�LLING \ r �€ �_ _ v - \ e REFERENCE ZONE: RF \18',7 :- ,� Q. Deed: C 135260 (#905) / ! Area min. 87120 RPOD \ 1 1 ROPOSD f i C 212176 (#923) (min.) ( ) PVI " ; EPTIC TANK° -- I Frontage min 20' \ _� l Plan: LCP 2664—L (#905) Width min) 125' E OUTS ' i Tennis Court LCP 2664-124 (#923) Setbacks: OL� -4.7 I Q ` \ , Fountain `o l Front 30 r e I "� w l Side 15' , R M �o i Rear 15' CL Garde t r ., op "�00 Vatch l i --r \ asin PROVIDE LEANOUTS \ N / `' i 1 ,t / �~ Pos I ... odes Beach \ Wboded�. r 1 l Trees \ _ € Are \ l Area i . sax. �� -- 1 . III f . \ N LOT CALCULATIONS \ o TH-1 Lot 255 PROVID 12'-10� ./ ' f �CLEANOU I Lot Area = 43,561 SF 3A= Jf \ Proposed Lot Coverage = 780 SF (1.87.) ��. L win p o ) Wooded ` \ 1 Area / ys, Proposed Floor Area = 780 SF (1.87) s 'li ;F E Catch o 1 Basin o y, \ \ Lot 256 moo\o -0 f,r ' Lot Area = 47,988 SF 1 ��o�e�sJ Lt \ Guest House m \ Proposed Lot Coverage = 4,665 SF (9.7q) �o \ x m o i ' ?zst Approk. Location �-- ; _ f �� \ Proposed Floor Area = 3,840 SF i I m L 'Sift % i 4,261 SF r / C tc \ 16.6 - i \\. f \\ ;: 3,668 SF ' a sx °st5 -� — �. -' 2,247 SF 255 ` w Total = 14,016 SF (29.2�) 43561 f s f,.4, B.M. $ K r Forage wi - ;� . 1.0 Acres EL. 1 \i i Apartmen � // M 2 l .yam ; . Above ., m awn " `, G ovei rive 1 o f ihnl \J � ' t \\ n Robert G. Bannish Trustee �N �►� ( \ \ Lot B13 889 Sea View Avenue Realty Trust LCP 2664L Dec `` \ 129,350f sf \ \ 2.97f Acres (Upland) f \ s y g Al - \ ) -Wooded `�town \ \N E k I TTINICS \ \ SBE WEM�;WD X A \ 01 941 Sea View LLC \ I ;' 'Iv , Vrden Deck 17.4 Guest 1 \ Garden Huse / ' Gravel '�� \ ' I 1 "' Drive v Veri t 1 \ N85�2 4 \ f \ ' ( \ ro } J 125. 0 #ch Light? `t o E OMH ., - B sin ` oo �y TH-3 Cobble Drive o -:4 o \ J Sept'�t� ?o �o \ y:, , " ra el N� As Perms �._ \ _. 009 J ' Ptan SERVE E r +'. Gravel ro \ }�ROPO$ED 7 c 72' \ J Drive I\/ i I \ VENT, I POP ` ED S.A. N 1 Sf 1K f 4 1 SE T is Lawn D o o } G Hse `.rn Pool Approx. _ awn\ s\\ 10N Location MI #905 25 I s,ii 51�� 2 Sty, w1f Dwelling 1 C IVOUTS rax= a F Approx. f \ \ 23ck i `D Location 5`�0 \ / PROPO� atio s r � z pVI�LL Py wf III I . . Garde t 1 �D w i1 in g 1 \ 00 at s8.7 i } a Patio i s Elev. 18.2' 19.1 Panel Pool ` J ~O POSED - - - _ - ` P^\0 Lawn _ _ _•__ _ __ 100' 21.8' x Lawn \, Raise `� i 'Lown j } Elev. 15.8 i, I y4J Patio \-i 100' Buffer Lot 256 ; 1? ' s 1 _ • \ 47,988± sf\ 1.1 f Acres \ \ j _.__•-- -- 50 B"ff }I 1 To Bottom Bonk \ --, __ _ _ __.L_•-- -- -- _ I Lawn � X (Min. Fl000d,;igk) / w j 1 _ \ � \ \ 100' �'� . FEMA Zone �-7 o \ 11 _�• X(0.�27, 71ood Chance)� 50 ���� A - \ i u+ \ 50' B• \ Lawn J } w 5101 � 1 �---- _ _ 1 50' � ., -- w _ T/�.. . oast al B�•'= f \ Lawn r _ J j =- �" - _ - gQ n ood s ' 10.83 i Beach ' av -9 -1;7r --At 64e 1, 12 tnd 1 __ _ ( �. ' '- Nance) _ .- .__ -- — �- - /E,ELE S _.. .. _ .- -FEMA ne �2 _ House 7 -�RR osa f �5' � F`o4cT C. _ — _6_ --- �E���V-115'i I,�ir-, �' �OAJ=�.- _� r ._`:�� .'�..-- 'FEM �/�14 Q_p 9 9ese•-Rog-e_/, F �-�' Eff�•c#ive" 16 _ ELEV 15 / Shack l_- : 1�� � - _ ) 1 `_ \ Tall Grass / VE !l ( j /Tall Grass' �- ' /. J __--- Buried Stone _ - ' j , / 4 / Revetment Per Man / l-'Buried Ston Buried Timber Bulkhead 1 Revetment Plan Per Plan -' s Timber Groin -� Per Plan a Nanticket Sound o JO #C. y o � v C? cn 43168 FGIgT FSS/GNAL ECG\ TITLE: Site Plan PREPARED BY. PREPARED FOR: NOTES: Engineering & 1) The property line information shown was compiled from CQ Proposed Improvements923 Cape View LLC available record information. _ atUConsulting, C/O Belmont Capital LLC 2) The topographic information was obtained from on on yInc. the round surve erformed on or between 55 Cambrid e PKWY ./�200 1 g y p September 923 Sea View Avenue (508)428-33"•P.O. Box 659.711 Main Street, Osterville MA 02655 g 11` 5, 2017 and February 27, 2019. Bamstable (Osterville) Mass. Cambrid e MA 02142 3) The datum used is NAVD '88. Bench mark set using seci�sullivanengin.com•wwwsullivanengin.com g RTK GPS. � 4) Before construction of additions, all dimensions & ^� Draft: CTR Field: WHK/CTR/JOD 30 0 15 30 60 120 locations are to be confirmed. Shown structure locations ,V DATE: May 15, 2019 SCALE: 1 » = 30, Review: CTR Comp./Review: CTR/JOD are approximate for permitting purposes only. Project: 370023 Pro lject: O'Donnell 20" MIN. -- - --- -- -- - -- -- 10 MIN _ -- — -- --� VF,1VT Nip•3839 �• � 2"LAYER OF r 171 CONCRETE COVERS I EL= 16.0 4" SCHI�DULE 40 P V C BASHED STONE EL= 16.5' AlIN PITCH I/g PER F7 Tr 4' CAST IRON PIPE G*J �T T OR B UAL AIIM.YUd! 2" Y14'R OF 1 LEVEL EL,=_12.4' CLEAN SAND 9" 1/B• - 1 t >/ASIIED .S7YJNL' N PI7LH 1/4 PER FT MR 2' - — � MIN ?!4' 1i? I-1 ��tRia- e � O FLOW LOVE --_— - - �__ EL= 13.0' �►as>fEv ENE / O T j0- -- - EXISTING -A(IN - -14� o 0 0 O O O O O C� L-1 0 INVERT Q,� IN \INVERT 24" o ° °� m .. 88 O 4, 8 / O 14_7' gA EL.__1_3_75" INVERT EL=_1_3.0' , °°o - - t° _10.4 I° 9 51 INVERT - ---— EL.= 1_3.2' 4.0' B.5" --- i_4.O, j EL.= 14.0' - -- DISTRIBUTION < '� 2,500 GAL ----- BOX TRENCH FORMA TION / SEPTIC TANK � DRY WELL "H-10" (10)-500 GAL. DRY WELLS �' END VIEW PROFILE 0 F (H-20 WHERE UNDER DR[VA'WA Y) I 623 SEWAGE DISPOSAL SYSTEM NO OBSERVED WATER TABLE (12/16197) + LOT 255 NOT TO SCALE BOTTOM OF TEST HOLI; ELEV.=_4-9_____ AREA==43 616_-1 S F. WEST ' BA Y OBSERVATION_HOLE I_-_- ELEV.___ 16.9 - / •5� �6 �1 DEPTH HORIZ TEXTURE _ COLOR NO77 0_THER 0 EL--- 16.0 0-10" STONE FILL �-�" OF SOIL TEST 12116197 EL= 15.4 10"-17 A SANDY LOAM! / ' � DATE WITNESSED BY: JERRY DUNNING 17"-46"/ B SANDY LOAM 10YR4/6 �- — — EL= 13.1 SOIL TEST DONE BY EDWARD PESCE. PE. � ` \� " C MEDIUM TO 5YR7/ PERC TEST WAIVED BY ,JERRY DUNNING 6 -1 44 COARSE SAND PERCOLATION RATE ASSUMED A T <5 MIN. INCH EL= 4.9 16/ NO GROUND WATER ENCOUNTERED VALVE / j E� LOT 8-20 ! EXISTING-` /IIIJJJ SEA /� INSTALL 2 TRENCHES W/(5) 500 GAL DRY WELLS ( WITH 4' CRUSHED STONES / j \ CESSPOOL" , / $� O �s 100, ON ALL SIDES) � �, , � 6 3��� � Lp� �/ NANTUCKET DESIGN CALCULA TIONS. \ SOUND 00 Io \ -- — -— / NUMBER OF BEDROOMS . . . . . . 11 50, __- GARBAGE DISPOSAL . . . . . . . . --- NO ---_ 03 I 1 / D 5 SEPTIC TANK. 11 BEDROOMS X 110 GAL/DA Y/BR X 2009,= 2,420 GAL/DAY 1` fc,� O�\ - Q� E �' LOCUS MAP REQUIRED TANK 2,500----- GAL SOIL CLASSIFICATION -- 1 GK DESIGN PERCOLATION RATE c_ 5 —___ MIN./IN. O\ EFFLUENT LOADING RATE -_- _ - _ 74_ —_--_GAL/DA Y/S.F y�� C�� /� ST O J, �� c� -9 6g PLAN REF. 2664-_ 124 EACH TRENCH SIDEWALL• 2(13.2' �- 50.5) X 2' X ( 74)=188.55 CAL/DAY ; ` / / E SY O r 1 RES. ZONE' RF--1 " BOTTOA1- 03.2' X 50.5)( 74)=493.28 CAL/DAY VAL \ CE 1�_: 6 ASSESSORS MAP 90 PARCEL 5 ?TOTAL ESTIMATED FLOW 110 11 1210 G.4L/DAY TOTAL AREA = 2.23E ACRES ( _____CAL/BR/DAY x _--._ BR) -_ TOTAL LEACHING CAPACITY (2)TRENCHES 1,364 GAL/DAY 15 0 '' EXISTING TREE BQ CESS OOLS - � O,�\ go-0 '==39 =----- - vAL o�.. SITE & SEPTIC _ ___________2:===_� �',����� '� �p PLAN OF LAND -- - - - ------- LOCATED A T.- 23 LO 1; B 1 .92�Y ,SF'A VIEW A V'NUE OS TE R VILLE MA. No �-' CON.0 �: COVER t" � \ j f� - <� !/J'` Y cawz PREPARED FOR.�� O 0''�` r1 l + 9F' �! ECWAap' �; A C ho l2ooEtLO T 256 o o ,� q `,�� KA THA RI1�T�' S F'O YT AREA=53,955.E S.F. ��' p35 9, fo'/sTE��o �n r QQ ` = I GENERAL NOTES Q '� MARCH 14, 1998 \ ��,,� 3N� 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM To n F,.P b TITLE 5 AND THE TOWN OF ___-- BARNST_ABLE_ RULES AND _. GRAPHIC SCALE o REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. J ' �► is sn F�� 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO zo WITHIN 6" OF FINISHED GRADE" OTHERS WITHIN 12" ? - — 1 J 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF �,.ti r WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 3 10 FT OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE T. ( [N FEET ) USED UNDER OR WITHIN 10 FT OF DRIVES OR PARKING AREAS ' ; 1 inch = 30 ft. 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTERED IN PLACE. 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH \ \ \o DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO PE SCE- E-N911VE-E R11V G & A S.0 �OCIA TE-S ` \ OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. P. O. BOX 521 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCA VA TION CONTRACTOR IS TO CALL 'DIG- SAFE" AT 1 800--322-4844 AT LEAST 72 HOURS OS TE R VIL L E-, MA. 026.5.5 PRIOR TO COMMENCING WORK ON SITE. ��\ \ 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS PH. (508)428- J7,30 SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. 8) PARCEL IS IN FLOOD ZONE___SEE PLAN . -- - --- / 9) LOT IS SHOWN ON ASSESSORS MAP _9D__ AS PARCEL 10) EXISTING CESS POOLS TO BE PUMPED & FILLED WITH SAND OR REMOVED. JOB# 51491 GM